Care of the Pediatric Patient
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Outline
Overview
- An increase in variables make children a more vulnerable patient group.
- Nurses must be attentive to ensure children are safe in healthcare environments as well as in their own homes with their caregivers.
Nursing Points
General
- Potential variables for pediatric patient
- Development
- Age
- Developmental milestones
- Safety risks
- Basic info
- Weight
- Medication & fluid calculations
- Dependency
- Non-verbal + high level of need = increased risk for abuse
- Different epidemiology and presentation
- Injuries most common cause of death
- Acute illness more common than chronic
- Illnesses specific to children (bronchiolitis, kawasaki’s disease, intussusception)
- Development
Assessment
- Initial observation of patient
- Age
- Weight
- Developmental capabilities
- Social interactions
- Hospital Environment & Equipment
- Suitable for age
- Child abuse
- Injury inconsistent with developmental capabilities
- Inconsistent stories/explanations
- Low self-esteem
- Bruises in the non-mobile child
- Inappropriate sexual knowledge
Therapeutic Management
- Patient Safety
- Environment
- Crib rails
- Safe sleep
- Medical equipment
- Age appropriate toys
- Medications & Fluids
- Always weight based
- Recognising child abuse
- Be aware of state laws on reporting
- Follow facility’s policy for who to notify first
- ALWAYS speak to someone more senior if you have a concern (You never have to nurse alone!)
- Trust your instincts
- Environment
Nursing Concepts
- Safety
- Patient-Centered Care
- Human Development
Patient Education
- Much of your education will be with caregivers.
- The more you communicate with them about what to expect during the shift the better your day will go!
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Transcript
Hello everyone. Welcome to your lesson on Care of the Pediatric Patient. I’m glad you are joining me here today to talk about pediatric nursing.
Let’s start off by looking at this photo of this little baby who obviously has a lot going on. Let’s imagine you are providing nursing care to this little one and it’s the beginning of your shift. What are the most basic and important things you can do to make sure that you provide safe care for him?
That’s what we are going to cover in this lesson.
Pediatric patients are a highly vulnerable patient group. We are going to look at the variables that make them vulnerable and highlight the ways this will impact your nursing care.
We will think of these variables as the 3 D’s – They are Development, Dependency & Different Epidemiology
If you only learn one thing from this lesson, let it be that everything we do is based on the child’s age and weight.
In pediatric medicine you may find yourself caring for children age 1 day to 18 years. The patient is constantly growing and changing at a rapid rate. This is probably one of the most overwhelming factors in peds, but if you always start with their age and weight, you can avoid so many of the safety issues that come up with pediatrics.
So why does age matter? Age is important because it guides us in terms of: 1) what to expect developmentally, 2) what vital sign ranges to look for, 3) what size equipment to use, 4) what our primary safety concerns should be (are there choking hazards in the room) 5) what toys can help us with distractions, 6) how to communicate. You get the idea. Plan your nursing care with their age and developmental level in mind and you can create a safe environment for any child you take care of.
Why does weight matter? The child’s weight is what all medication doses and fluid calculations are based on. Without an accurate weight the child is at risk for receiving incorrect doses of meds and fluids.
Okay- so remember, start with age and weight and you can work everything out from there.
The next variable is dependency- and by this I simply mean that children are not independent. They need help from others to survive. When you combine being non verbal with having high levels of need you get an increase risk for abuse. For our pediatric patients those at greatest risk are infants who are less than 6 months and children who have chronic illnesses.
Unfortunately, in the pediatric world we have to maintain a certain level of suspicion regarding child abuse. We of course, never want to think the worst can happen but if you don’t think it, you won’t spot it.
Remember, the topic of abuse is covered in great detail in the Fundamentals course, so if you need a refresher on this topic please take a look at it.
All I want to do here is highlight some red flags that are specific to pediatric patients. First, we are always concerned if the injuries do not match with a child’s developmental capabilities. For example, a 2 week old is not developmentally capable of rolling off a bed or sofa to cause an head injury or bruise. Along these same lines, bruises in a non-mobile child are always going to be investigated because they aren’t moving around and couldn’t create enough force to cause a bruise. Other things to look out for are inconsistent explanations of how the injury occured, low self esteem and inappropriate sexual knowledge.
If you suspect abuse at all, make sure to speak to a senior nurse who will be familiar with state laws and your facilities policies.
I know this topic is such a downer! But it is so important to have astute nurses looking out for children. If you keep your sights on the kids and get support from other nurses you will be able to manage the care appropriately.
The last set of variables we are going to look at has to do with the the fact that pediatric illnesses have a different epidemiology than adult patients. All this means is that the factors contributing to their illnesses are different. For example, the most common causes of death and disability in children are accidents and injuries. Because of this, pediatric nurses spend a lot of time educating parents and caregivers about preventing injuries and accidents.
Another difference for pediatric patients is that they are more likely to present with episodes of acute illness in the midst of general wellness, as opposed to adults who are more likely to present with exacerbation of chronic illnesses.
This brings up another concern a lot of people have with peds. Many of the illnesses you will come across are unique to childhood. This can make your peds course feel a bit overwhelming because you feel like it’s all new content. It’s not though! In spite of this list of new diagnoses a lot of what you already know about medical surgical care will still apply.
Let me give you a quick example – Intussusception is a specific problem that can occur in the bowel of infants and toddlers. It usually requires surgical intervention. When you encounter this child during clinical, don’t panic. It’s a bowel problem- tiny bowels, but still bowels. You already know that a patient who just had abdominal surgery needs to be NPO and needs IV fluid. You know you need to assess for bowel sounds and manage their pain so they can get moving. So, slightly new and different, but not completely. If you think critically and prioritize patient safety you will be fine.
So, what are our priority nursing concepts here? Obviously the first is safety- that’s what all of this is about keeping them safe by assessing for abuse and creating a safe hospital environment. The second and third concepts to prioritize are patient-centered care and human development.
Okay, let’s go back to our little baby that we started the lesson with. We asked the question – What are the most basic and important things you can do to make sure that you provide safe care? We answered this question by looking at the 3 D’s, Development, Dependency and Different Epidemiology. The most important things you can do for this baby and also your key learning points are: 1) identify the variables- starting with age, weight, development and level of dependency 2) based on this information create a safe hospital environment- so like we said earlier, setting your monitors to the right age range, using equipment that’s the correct size, making sure there aren’t any choking hazards in the room- all those things we discussed earlier and lastly 3) always assess for abuse. If you remember these three things you have the basics for providing safe pediatric care.
That’s it for our lesson on Care of the Pediatric Patient. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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- Communication
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- Delegation
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- Newborn Care
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- Disorders of Pancreas
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- Pregnancy Risks
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- Substance Abuse Disorders
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- Prenatal Concepts
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- Basics of Chemistry
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- Fetal Development
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- Neurologic and Cognitive Disorders
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